When You Ask The Wrong People by Pat Conrad MD

This article caught my eye last week, and once in awhile, I like to respond to such by writing the author.  Usually, I don’t get a reply, but one remains hopeful.

Author Elaine Howley is “a freelance Health reporter at U.S. News. An award-winning writer specializing in health, fitness, sports and history…”  who wrote “about the lack of primary care or family physicians in the United States…”  She reports that the Assoc. of American Medical Colleges predicts a primary care physician shortfall of between 8,700 and 43,100 by 2030 (and with estimates as precise as those, we still keep asking academia to help shape policy, ahem).  But she says nice things about the importance of PriCare to good health, and then bless her heart, immediately starts quoting the AAFP:  “as many as 127,617 deaths per year in the United states could be averted through an increase in the number of primary care physicians available.”  If this is true, then one could argue that the AAFP is culpable by running ever larger numbers out of family medicine.

Oh bless her heart again.  Her next source is Dr. Warren Newton, “incoming president and CEO of the American Board of Family Medicine,” a noted extortion racket also contributing to fewer family doctors in the coming years.  He recommends seeking other sources of care – ironic, that – while “Dr. Michael Munger, president of the American Academy of Family Physicians, also recommends reaching out to a local medical society.”  I honestly laughed out loud at that one.

She quotes an ER doc who suggests going to urgent care clinics or calling the hospital for the names of local doctors, but never once mentions the come-on-in effects of EMTALA.

The source she refers to as “Warren” (I presume the head of the ABFM shakedown syndicate mentioned above) says we should not get hung up on the term “primary care physician.” He says PCP’s take care of all sorts of problems, and in fact, “you can sometimes find this sort of health ally in several places, not just a PCP or family doctor.”  The incoming boss of the ABFM License Lien Inc. actually said that.  Not to be outdone, his partner in mendacity, Munger, head of the AAFP jumps in by comparing PriCare to a team sport that needs more NP’s, PA’s, as “very valuable as part of the overall team.”  Hold your fire NP’s and PA’s, I’m not jabbing you here.  I’m showing contempt for this creampuff, another Vichy turnover, which is undercutting the very profession whose shrinkage he laments.  Munger whines to the author about excessive school debt, rising administrative burdens, and lack of role models.  He hopes to address the latter with the “Teaching Health Center Graduate Medical Education Program. This program funds community-based primary care residency programs. “These primary care and family residency training programs are embedded in community health centers and federally qualified health centers in rural and underserved communities.”  I’m betting the author doesn’t realize how crushing these would-be role models will find the mandated EHR’s, quality indicators, and general life-dissolving BS that will come with those federal dollars.  A lot of those “role models” will end up looking for work in the ‘burbs, maybe as part of multi-specialty clinics owned by specialists.

Ms. Howley ends with:  “The hope is that in time, these and other efforts will lead more doctors to select primary care so that the rest of us won’t have to worry about who to call when we get sick.”  I was nice in my note to her – really! – but had to give her the truth.  In trying to understand the problem, she went to two of the biggest culprits in creating the problem.  The things that make establishment, mainstream PriCare so unfulfilling and financially untenable have been by and large supported, even cheered by the AAFP, with the good ‘ol ABFM standing behind us, sharpening the shiv.  I asked her to talk to some trenches family docs, to learn about Direct Primary Care, and offered to put her in touch with a leading voice in the movement.

What would you have told her?

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